AirCare 4 · 18 min · rotor

Pregnant trauma — 31 weeks

PaCO₂ 30–34 physiology · 6 mL/kg ARDSNet · 92–96% (trainer band — avoid hyperoxia) · 6 mL/kg PBW (4–8) · Pplat ≤30 · ΔP ≤14 (trainer) · PaCO2 30–34 (third-trimester baseline)

31-year-old, G2P1 at 31 weeks, restrained passenger, T-bone at 45. Tender LUQ, sat 90% on NRB, now tubed 7.0. Fundus at the xiphoid. Left uterine displacement on the stretcher.

Handoff

Two patients. She needs 6 mL/kg and a higher minute ventilation than a non-pregnant adult — progesterone already kept her PaCO2 in the low 30s. Do not park her at 40 and call it lung protection. Avoid hypocapnia that starves the placenta, and do not crush venous return with heroic PEEP.

1
PaCO2 ~30–34 — her pregnant baseline
Normal 40 is a relative hypoventilation in the third trimester.
2
6 mL/kg PBW, Pplat ≤30, ΔP ≤14
Use her height, not the gravid weight. IBW is not 94 kg.
3
MAP ≥70 and keep LUD
Aortocaval compression plus high Paw = two pale patients.

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